Effectiveness of Solution-Focused Brief Therapy (SFBT) on Depression and Perceived Stress in Patients with Breast Cancer

Background: Attending to psychological status in patients with breast cancer, because of expanded damage and mortality in these patients, is important. The present study investigated the effectiveness of Solution-Focused Brief Therapy (SFBT) on depression and Perceived Stress in Patients with breast cancer. Materials and Methods: This research was a semi-experimental with pretest, post-test and follow-up (1 month), which was conducted from November to February, 2016. In this study, 30 patients with breast cancer who attended Imam Hossein Hospital in Tehran city were selected by convenience sampling method and randomly were assigned in 2 experimental (n=15) and control groups (n=15) and Cohen’s Perceived Stress Scale and Center Epidemiological Studies Depression Scale were administrated as pretest. Experimental group received 8 sessions of Solution-Focused Brief Therapy SFBT and control group received no intervention. At the end, post-test was administrated on two groups and, repeated measure multi-variable method was used for data analysis by SPSS-21 software. Results: The results of the present study indicated that there were significant differences between the experimental and control groups after administrating SFBT. Thus, the mean of depression and perceived stress of experimental group decreased (P<0.001). Conclusion: The result of study that showed SFBT is effective in decreasing depression and perceived stress in patients with breast cancer. Therefore, in order to improve the positive psychological state in these patients psychological screening must be performed and if needed clinical trials and appropriate intervention be considered.


INTRODUCTION
The increased prevalence of cancer in recent years and its impact on various aspects of physical, psychological and social life have led to cancer being recognized as a major health problem of this century (1). Cancer is one of the most common non-infectious diseases caused by an impairment in the rate of cell proliferation and differentiation, and by attacking healthy tissues of the body causes severe illness and, as a result, death (2). Types of cancers are a wide range of diseases, each of which has its own etiology, therapeutic, and prognostic basis (3).
The most common and most influential type of cancer among women is breast cancer, emotionally and psychologically (1), with a prevalence of five year-survival TANAFFOS Aminnasab A,et al. 273 Tanaffos 2018; 17 (4): [272][273][274][275][276][277][278][279] rate of about 80 to 95% in women (4). Breast cancer is not considered as a deadly disease today and is increasingly recognized as a curable disease (5). However, the process of diagnosis and treatment of this disease is highly stressful (4). Long-term stress causes an increased risk of depression (6). Psychological factors such as depression increase the mortality rate of patients with breast cancer.
The prevalence of depression in women with breast cancer is estimated to be more than 37% (4). Many women with breast cancer report depression symptoms that are very serious, but are below than threshold rate of symptoms for major depression diagnosis (6). However, in either case, depression symptoms are highly effective in breast cancer symptoms. The main symptom of depression in women with breast cancer is an overwhelming fear of recurrence and metastasis (7). Indeed, the suffering from the disease, the concern of the future of family members, the fear of death, the complications of treating the disease, reducing the amount of daily functions, mental impairment and sexual problems are some of the important factors that predispose the continuation of depression in these patients (1,8).
Also, another psychological variable that appears to have a significant role in the prediction of suicide in the woman with breast cancer is perceived stress (9). Stress is a condition in which biological, psychological, and environmental factors interact (10). Other study has shown that stress can lead to rapid progression of cancer disease and severe physical and psychological consequences for patients (11). Perceived stress is a mode that reflects the overall assessment of the importance and severity of environmental and personal challenges. Therefore, these individual and environmental factors are important in understanding the stressors (10). Considering the many negative effects that depression and stress have in the process of the disease and the trend of breast cancer, conducting researches is needed to identify the effective factors in reducing these psychological variables.
One of the most effective therapeutic interventions to help people who suffer from stress and depression is Solution-Focused Brief Therapy (SFBT) (12). This therapy was initiated in the early 1980s at Brief Family Therapy Center in Milwaukee. SFBT was developed by two social workers called Steve De Shazer and Insoo Kim Berg and their colleagues who sought to investigate short-term therapeutic effects and techniques for helping patients change (13).
Although the history of SFBT is short, in recent years, this approach has become popular among counselors and mental health professionals around the world (14). The Given what has been said, it seems that SFBT is important for improving the depression and perceived stress of patients with breast cancer. Therefore, the present study was conducted with the aim to evaluate the effectiveness of SFBT on depression and perceived stress in patients with breast cancer.

MATERIALS AND METHODS
The present study was a semi-experimental with pretest, post-test, and control group. The statistical population of this study was all patients with breast cancer referring to Imam Hussein Hospital in Tehran during the study. In order to calculate the sample size, according to the fact that the proper sample size was 15 people for each group (15), the sample size was selected equal to 15 people for each group.
The inclusion criteria to this study included diagnosis

Demographic sheet sample
This sheet sample included the age, sex, level of education and marital status of the patient, which was provided and assessed by the researchers in this study.

Cohen's Perceived Stress Scale (PSS)
This tool was developed by Sheldon Cohen in 1983 and has 3 versions with 4, 10 and 14 items used to measure perceived general stress over a past month. Each article is graded based on the 5-degree Likert range from never (0 score), to very often (4 scores), and questions 4, 5, 7, 9, 10 and 13 are reversely scored. Finally, the score will be between 0 and 56. A higher score represents more perceived stress (16). Cronbach's alpha has been considered equal to 0.84, 0.85 and 0.86 (17).

Center Epidemiological Studies Depression Scale (CES-D)
The Center for Epidemiology Studies used the Depression Scale (CES-D) to assess depressed mood, which is a self-report questionnaire with 20 items which is designed for assess symptomatic depression scale.

Respondents graded their depression on a 4-point scale to
the extent that they experienced signs last week. The probable range score of this questionnaire is from 0 to 60,  Beauchemin (23) in the different samples and researches.
In explaining this finding, it can be argued that therapists of SFBT use many techniques that reduce stress.
One of these techniques is the use of grading techniques.
Most grading questions are used to measure progress during therapeutic sessions. Grading questions want clients to rank their status or goal with scales from 1 to 10.